A Review of the Toxicologic Implications of Obesity

Zuckerman, Matthew; Greller, Howard A.; Babu, Kavita M.

doi:10.1007/s13181-015-0488-6

Cited by 26 publications

(30 citation statements)

References 126 publications

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“…In particular, the volume of distribution of lipophilic medications is affected by excess adiposity. Lipophilic medications tend to readily disperse into adipose tissue, making it difficult to achieve therapeutic plasma levels [45]. …”

Section: Challenges In the Pharmacologic Management Of Hypertension Imentioning

confidence: 99%

Hypertension in Obesity and the Impact of Weight Loss

Cohen

2017

Curr Cardiol Rep

113

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Purpose of Review Several interrelated mechanisms play a role in the development of hypertension in obesity, often contributing to end organ damage including cardiovascular disease and chronic kidney disease. Recent Findings The treatment of hypertension in obesity is complicated by a high prevalence of resistant hypertension, as well as unpredictable hemodynamic effects of many medications. Weight loss stabilizes neurohormonal activity and causes clinically significant reductions in blood pressure. While lifestyle interventions can improve blood pressure, they fail to consistently yield sustained weight loss and have not demonstrated long-term benefits. Weight loss surgery provides more permanent weight reduction, corresponding with dramatic declines in blood pressure and attenuation of long-term cardiovascular risk. Summary Hypertension is closely linked to the prevalence, pathophysiology, and morbidity of obesity. There are multiple barriers to managing hypertension in obesity. Surgical weight loss offers the most promise in reducing blood pressure and decreasing end organ damage in this patient population.

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Section: Challenges In the Pharmacologic Management Of Hypertension Imentioning

confidence: 99%

Hypertension in Obesity and the Impact of Weight Loss

Cohen

2017

Curr Cardiol Rep

113

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“…There is a lack of consensus on dose adjustments for specific drugs in obese paediatric patients. One of the main reasons is absence of clinical trials that can support evidence‐based dosing strategies .…”

Section: Introductionmentioning

confidence: 99%

“…The deficiency of trials has led to both over and under dosing of these patients , as obesity is more than a biometric measure. Due to changes in anatomy and physiology, obese children may respond differently to pharmacological exposures .…”

Section: Introductionmentioning

confidence: 99%

Higher chlorzoxazone clearance in obese children compared with nonobese peers

Gade

Dalhoff

Petersen

et al. 2018

Brit J Clinical Pharma

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“…Zuckerman et al . advocate that obese patients should be considered as a special population and included as standard in all clinical trials, as well as introducing the requirement to record body mass index (BMI) in all post‐authorization safety studies (PASS). This idea, although currently peripheral, is likely to become more accepted as obese people represent a significant and growing proportion of the global population, and this is particularly pronounced in areas of high immunoglobulin (Ig) use.…”

Section: Introductionmentioning

confidence: 99%

“…Optimum dosing of immunoglobulin remains a hotly debated topic in general for both replacement and autoimmune indications [5,6], so tackling this topic in a subset of patients who are not well represented in research [7,8] is challenging. Zuckerman et al [9] advocate that obese patients should be considered as a special population and included as standard in all clinical trials, as well as introducing the requirement to record body mass index (BMI) in all post-authorization safety studies (PASS). This idea, although currently peripheral, is likely to become more accepted as obese people represent a significant and growing proportion of the global population, and this is particularly pronounced in areas of high immunoglobulin (Ig) use.…”

Section: Introductionmentioning

confidence: 99%

Considerations for dosing immunoglobulin in obese patients

Hodkinson

2017

Clinical and Experimental Immunology

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SummaryObesity is a very common condition; however, the effect of excess body weight on the appropriate dose of immunoglobulin has not been defined empirically. The proposed pharmacokinetic differences between lean and obese patients and the opportunity to reduce costs has led to the proposition that obese patients should receive proportionally lower doses of immunoglobulin once a certain threshold is reached. Here the theoretical factors which could affect dosing in obese patients are considered alongside the available empirical evidence. The available evidence indicates that obesity may affect the pharmacokinetics of immunoglobulin; however, the effect is likely to be too small to have a clinically important effect on dosing. Wide interpatient individuality and highly variable clinical need mean that obesity should not play a major factor in dosing considerations. However, patients who are obese are more likely to have multiple cardiovascular risk factors and their weight indicates a large dose. This puts these patients at a higher risk of adverse reactions, and therefore caution is advised.

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A Review of the Toxicologic Implications of Obesity

Cited by 26 publications

References 126 publications

Hypertension in Obesity and the Impact of Weight Loss

Hypertension in Obesity and the Impact of Weight Loss

Higher chlorzoxazone clearance in obese children compared with nonobese peers

Considerations for dosing immunoglobulin in obese patients

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